Thank you for your question.
You submitted a photo and you described that you’re 51 and you're demonstrating the concern
you have about jowls.
And you're asking, “What happens to the jowl fat during the face and neck lift?”
And you're asking about the method whether it’s reposition or what is done, or is it
customized.
Well, I think I can give you some perspective from my – from what I do in my practice.
I’m a board certified cosmetic surgeon certified by the American Board of Cosmetic Surgery
and a fellowship-trained Oculofacial Plastic and Reconstructive Surgeon practicing in Manhattan
and Long Island for over 20 years.
Face-lifting – face and neck lifting is a very significant part of my practice.
And I can share with you what my approach is and a little bit of how it’s evolved
over the years.
To answer your question, essentially, the answer is it’s – it is – it has to be
customized.
No two people can have exactly the same procedure.
And when you do your research and meet with doctors, you will get varied opinions on what
is the best way to do what you want.
And so you’ll have to kind of filter them and see which one you're most comfortable
with.
But to understand the jowls, it’s very important to also understand anatomy.
And it’s part of the reason why there’s a lot of people who have had sub-optimal results.
Whether it is with the face-lifting surgery, whether it’s with an injectable, or whether
it’s with a thermal heating device that claims to be able to lift the face.
So let’s understand the anatomy a little bit.
You see the term jowl can mean basically one thing, it’s the absence of clear definition
of a jawline.
What contributes to the jowl appearance is actually can be several things.
We’ll start with the level of – at skin deep at the – right below skin.
Right below the skin where the skin hangs over, there can be a small amount of fat.
Now this fat can be defined as fat that has shifted downwards.
So the question about repositioning is certainly a valid question.
Some people would feel that the fat represents fat that is not only moved downward, but it’s
kind of separate and we sometimes see this in face-lifting surgery.
And in certain situations like that, the fat can be excised.
Now how it’s excised, some people will do liposculpture first and then do the lift or
would do direct excision.
The other factor that’s often under-appreciated is part of the jowl, the appearance has to
do with something called the buccal fat.
Buccal fat is fat that’s in a very distinct compartment which is – which creates a certain
amount of fullness.
There’s actually two types of situations with buccal fat.
One is where there is kind of like a diffused, localized fullness and then there’s something
called buccal fat herniation where the fat protrudes out and almost – then creates
this roundish little bulge.
The point is that you don’t have a one standard approach and system that is going to work
the same for everybody.
In my practice, when I’m doing surgery, this is often a dynamic process.
Yes, I have a certain – I make certain observations and determinations before surgery.
But doing surgery, as I’m doing the work, as I’m lifting – as I’m moving the muscle,
the layer, called the SMAS or Superficial Muscular Aponeurotic System, I’m looking
at the contour when I’m making decisions.
I’m looking to see if buccal fat is prolapsing outward.
Sometimes I’ll take that buccal fat from the inside of the mouth before I actually
do a lift.
When I – when I mentioned about the evolution of this procedure, in my practice, I can tell
you that there was a time where it was almost a given that any patient who have a little
bit of jowl fat and a little bit of fat under the chin would get liposuction first before
the beginning of the surgery.
In my practice, [in my?] – for me, it’s evolved.
I’m actually more conservative about the application of liposuction before doing the
face-lifting and more doing something like a liposculpturing with direct excision where
I’m not traumatizing the tissue as much.
Now that’s my style and my take.
I do all of my facelifts under local anesthesia with light sedation.
This allows me to do this procedure with the patient more comfortable post-operatively
and also it allows me to position the face and not have a tube in the throat that gets
in the way of me evaluating the angle.
This is a very – just a dynamic process, the way I do it.
And I feel like I get – I get more information and more ability to judge when I do it this
way.
Our patients appreciated it because they don’t have to go under general anesthesia and they
also feel really good after their surgery.
They don’t feel like they’re knocked out but that’s a separate topic.
I think that when you – as I said, when you are meeting with doctors and when you're
doing research, you’re going to see a lot of claims of procedures by name like a Deep
Plane Facelift.
I had someone to saying that their preferred method is another type of facelift.
You know, a competent and experienced cosmetic surgeon knows all those methods and has a
lot of experience with all those methods.
So really, it’s about the style and the aesthetic outcome.
What is a great result for one surgeon who likes a more natural result may not be aggressive
enough to someone who wants a more exaggerated result.
And this is the why there’s a varies – there’s a variability in the aesthetics and style
in doctors.
We’re all individuals with our own style.
And then, of course, you can judge that by looking at the doctors’ before and after
pictures and getting a sense of your rapport in conversation in – during consultation.
So to once again, to answer the question, in my practice I feel it’s very important
to customize.
It’s very important to understand the different options.
And then last, I would also mention that something that’s also under appreciated is that the
bone at the point where the jowl is, right in front of the jowl, is called the mandibular
notch.
This is an area which is indented.
So when you think about it, even when you lift, if the bone is still indented, you may
feel that there’s a little bit of a jowl left.
So – to example of how we approach this, we can approach it by putting some type of
facial implant like a pre-jowl implant or you can do it later after the surgery.
And it’s something that we do more, you know, with our patients it is we advise them
that there’s the presence of this indentation.
And what we do in our practice non-surgically, it’s something called the wire lift.
And for people who are good candidates who are going to go and have face-lifting surgery,
the wire lift is a great option where we use fillers such as Juvéderm, Ultra Plus, and
Juvéderm Voluma to place under the muscular layer to create more continuity in the jawline.
And for people who’ve had facelifts in the past, who have this little notch area and
think they need a lift again, they really see the benefit of doing this procedure that
takes less than 30 minutes.
It’s not even surgery, it’s actually an injection procedure and creates great results.
So when you think about the jowl, yes, it’s one term to describe the lack of continuity
of a jawline.
But there are at least three distinct factors: there’s fat under the skin, there’s fat
from the buccal fat pad, and then there’s the upset, a resorption of bone.
Remember, facial aging is a combination of volume loss from bone, muscle, and fat, as
well as dissent.
So understanding all of that I think will help you really make the right decision when
the time is right for you.
So I hope that was helpful.
I wish you the best of luck.
Thank you for your question.